Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

Featured on Channel NewsAsia

Cartilage Injuries

SYMPTOMS

There is a gradual or acute on set of effusion and exercise-induced pain often combined with mechanical problems of locking, clicking, clunking or discomfort on impact (compression and rotation). This injury is common in sports such as football, rugby and other high-intensity contact sports but can also occur gradually in sports where hypermobility is important, such as ballet, gymnastics and martial arts.

AETIOLOGY

In many cases this injury occurs from direct or indirect trauma or in association with other ligament injuries.

CLINICAL FINDINGS

There is effusion in most cases. The compression rotation test is positive. There is often tenderness on palpation of the affected joint line and there are complementary tests for the same purpose. Since there are often associated injuries, examination must also include tests for ligaments, menisci and capsular structures.

INVESTIGATIONS

Clinical examination is the most important tool for diagnosis and should include tests for all ligaments and other structures in the knee. X-ray is valuable to rule out fractures, in particular in growing or elderly athletes. Note! MRI can sometimes miss significant cartilage injuries but is valuable for evaluating associated injuries.

TREATMENT

An athlete with effusion and suspected cartilage injuries should be seen by an orthopaedic surgeon to consider arthroscopy. This procedure can not only verify the diagnosis but also deal with associated injuries. Minor cartilage injuries are debrided or vaporised and loose bodies excised. Full-thickness cartilage injuries on weightbearing surfaces can be micro-fractured to stimulate growth of fibro-cartilage, which fills the gap and provides reasonable support. Other, more complicated cartilage procedures, such as cell transplantprocedures, are still experimental and their longterm outcomes are not superior to micro-fracture.

REFERRALS

Refer to orthopaedic surgeon for further investigations to verify the extent of the injury. Physiotherapists will be involved in close collaboration with the surgeon.

EXERCISE PRESCRIPTION

Rest is only recommended temporarily. Cycling and swimming are good alternatives to keep up general fitness.
Rehabilitation back to full sport usually takes a long time, up to 12 months or more.

EVALUATION OF TREATMENT OUTCOMES

Monitor clinical symptoms and signs. Different functional knee scores for different sports are available to measure when the knee allows the return to full sport.

DIFFERENTIAL DIAGNOSES

Meniscus injury, loose bodies, medial plica syndrome; all differentiated by arthroscopy.

PROGNOSIS

Surgery will allow a return to professional sports in anything from two weeks to several months. The knee with serious cartilage damage is more vulnerable to stress and in the long term, 10 to 20 years, the risk of developing osteoarthritis is significant compared to a non-injured knee.

Leave a Reply

You can use these HTML tags

<a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <s> <strike> <strong>